Provider Demographics
NPI:1295279826
Name:REDMON, CAROLYN DENISE (RN)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:DENISE
Last Name:REDMON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 BROLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-7411
Mailing Address - Country:US
Mailing Address - Phone:678-570-5569
Mailing Address - Fax:
Practice Address - Street 1:3330 CUMBERLAND BLVD SE
Practice Address - Street 2:SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5995
Practice Address - Country:US
Practice Address - Phone:678-638-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN074038163W00000X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No372500000XNursing Service Related ProvidersChore Provider